Is the 'Death Triad' a Casualty of Modern Damage Control Resuscitation
| Autor: | Rebecca Schroll, Danielle Tatum, Sharven Taghavi, Max Shapiro, Alison Smith, Juan Duchesne, Vera Hendrix, Chrissy Guidry |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Resuscitation medicine.medical_specialty Multivariate analysis Damage control resuscitation Abdominal Injuries Hypothermia Risk Assessment Young Adult 03 medical and health sciences Triad (sociology) Injury Severity Score Postoperative Complications 0302 clinical medicine Risk Factors Internal medicine Coagulopathy Humans Medicine Hospital Mortality Aged Retrospective Studies Aged 80 and over business.industry Incidence Incidence (epidemiology) Trauma center Blood Coagulation Disorders Middle Aged medicine.disease Survival Analysis Treatment Outcome 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Surgery medicine.symptom Acidosis business |
| Zdroj: | Journal of Surgical Research. 259:393-398 |
| ISSN: | 0022-4804 |
| Popis: | Principles of damage control laparotomy (DCL) focus on early surgical control of hemorrhage and contamination in addition to damage control resuscitation (DCR) to combat the significant mortality associated with the "death triad" of hypothermia, acidosis, and coagulopathy. We hypothesized that DCL patients managed with DCR would have lower mortality from the death triad than historical studies.A 5-y retrospective chart review of all consecutive adult trauma patients presenting to a Level I trauma center who underwent DCL was conducted. Parameters associated with the death triad were evaluated on admission and 24 h after the presentation. Kaplan Meier survival plots were used to compare the components of the death triad. Univariate and multivariate analyses were performed.A total of 149 adult patients were identified. The overall incidence of death triad was 20.8% (n = 31/149). 24-h mortality for all patients was 5.4% (n = 8/149). Kaplan Meier plots showed that 24-h mortality was significantly increased if 3/3 components of the death triad were present (P 0.05). At 24-h after admission, mortality occurred in 16.6% (n = 5/30) of patients with the death triad.This study confirms that the 24-h mortality of trauma patients increased with the addition of all three death triad components. The death triad predicted death in 16.6% of patients treated with DCL and DCR at 24 h. Results suggest that the death triad might not be as applicable in the modern era of DCL in combination with DCR. Other factors contributing to in-hospital mortality need to be further elucidated. |
| Databáze: | OpenAIRE |
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